Left-Side Pressure Index for All-Cause Mortality in Older Adults with HFpEF: Diagnostic Potential for HFpEF and Possible View for HFrEF

Hoshida, Shiro

doi:10.3390/jcm12030802

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…9 This noninvasive index shows the ratio of LA filling pressure to LV end-systolic pressure and is a significant index of all-cause mortality in a multivariate Cox proportional hazards regression analysis performed by adjusting for age, comorbidities, natriuretic peptide levels and echocardiographic indices in elderly patients with HFpEF. 10,11 Stress tests cause an elevation of systolic blood pressure, and the extent of the change in blood pressure is different in each patient. Using an index such as Ed/Ea, the conflicting consequences described above may disappear.…”

Section: Symptoms (-)mentioning

confidence: 99%

“…Since LV diastolic function is affected by afterload, we recently evaluated LV diastolic function as a vascular resistance‐integrated index: the ratio of LV diastolic elastance (Ed) to arterial elastance (Ea) = ( E / e ')/(0.9 × systolic blood pressure) 9 . This noninvasive index shows the ratio of LA filling pressure to LV end‐systolic pressure and is a significant index of all‐cause mortality in a multivariate Cox proportional hazards regression analysis performed by adjusting for age, comorbidities, natriuretic peptide levels and echocardiographic indices in elderly patients with HFpEF 10,11 . Stress tests cause an elevation of systolic blood pressure, and the extent of the change in blood pressure is different in each patient.…”

Section: Introductionmentioning

confidence: 99%

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Discovering HFpEF in symptomatic and asymptomatic elderly outpatients to prevent hospital admission

Hoshida¹

2023

Eur J Clin Investigation

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Section: Symptoms (-)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Discovering HFpEF in symptomatic and asymptomatic elderly outpatients to prevent hospital admission

Hoshida¹

2023

Eur J Clin Investigation

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“…Because all of the study populations using our proposed index for prognostication included those with hospitalization only, this limits the generalizability of our findings to HFpEF outpatients with no history of hospitalization. The possible clinical utility of this unique index is expected to reveal older, symptomatic outpatients with HFpEF and "pre-HFpEF" outpatients without symptoms [19,52]. The criticism is that there is no external validity to this index.…”

Section: Futured Perspectivesmentioning

confidence: 99%

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction

Hoshida

2023

JCM

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Of the existing non-invasive diastolic indices, none consider arterial load. This article reveals points of caution for determining the diastolic prognostic index using a novel index of vascular resistance-integrated diastolic function in old, real-world patients with heart failure with preserved ejection fraction (HFpEF) in Japan. This index represents the ratio of left ventricular diastolic elastance (Ed) to arterial elastance (Ea), where Ed/Ea = (E/e′)/(0.9 × systolic blood pressure), showing a relative ratio of left atrial filling pressure to left ventricular end-systolic pressure. The role of hemodynamic prognostic factors related to diastolic function, such as Ed/Ea, may differ according to the clinical endpoint, follow-up duration, and sex. In HFpEF patients with heterogenous cardiac structure and function, an assessment using a serial echocardiographic diastolic index in clinical care can provide an accurate prognosis.

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Alternative Factors in Possible Involvement of Coronary Microvascular Dysfunction in Older Patients with HFpEF

Hoshida,

Watanabe,

Masunaga

et al. 2024

JCM

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Objectives: Coronary microvascular dysfunction (CMD) is associated with many heart diseases, including heart failure (HF) with preserved ejection fraction (HFpEF). Invasive examinations for CMD detection are difficult in older patients with HFpEF, and the decision criteria for noninvasive CMD measurements are unclear. We aimed to identify alternative factors in the possible involvement of CMD in the progression and prognosis of HFpEF. Methods: We analyzed 607 patients with HFpEF who were hospitalized for acute decompensated HF without a history of coronary artery disease (CAD). Blood tests and transthoracic echocardiography were performed. We focused on left ventricular hypertrophy (LVH) and coronary perfusion pressure (diastolic blood pressure, dBP). Results: The patients with LVH showed reduced diastolic function (E/e’) and a lower incidence of atrial fibrillation (AF) compared with those without LVH, with no differences in age or dBP. No differences were observed in all-cause mortality between patients with low and high dBP without LVH. In the patients with LVH, the incidence of all-cause mortality was significantly higher, with a lower incidence of AF, reduced renal function, and higher C-reactive protein levels in those with low dBP than in those with high dBP. The comprehensive diastolic functional index, diastolic elastance/arterial elastance, was markedly higher in the patients with LVH, especially in those with all-cause mortality. This index, but not E/e’, was a significant prognostic index in the multivariate Cox hazard analysis when adjusting for age, sex and N-terminal pro-brain natriuretic peptide levels. Conclusions: LVH and dBP were clinically important factors in elderly HFpEF patients without a history of CAD.

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Left-Side Pressure Index for All-Cause Mortality in Older Adults with HFpEF: Diagnostic Potential for HFpEF and Possible View for HFrEF

Cited by 3 publications

References 12 publications

Discovering HFpEF in symptomatic and asymptomatic elderly outpatients to prevent hospital admission

Discovering HFpEF in symptomatic and asymptomatic elderly outpatients to prevent hospital admission

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction

Alternative Factors in Possible Involvement of Coronary Microvascular Dysfunction in Older Patients with HFpEF

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